We are proposing a coherent 5-year training plan for the acquisition of basic epidemiologic and health services research skills necessary to investigate the long-term medical effects of sexual abuse. This will include an integrated program of seminars, didactic course work and clinical research designed to foster development as an independent investigator. Specifically, we propose a study of long-term medical effects of sexual abuse victimization using an established population laboratory in a large, 45-year-old health maintenance organization (HMO) in the Pacific Northwest. This HMO setting affords a unique opportunity to study this association since nearly all the health care utilization is contained in one system and is tracked using automated data that can monitor medical and mental health ambulatory visits, hospitalizations, medical tests and prescriptions. Most importantly we have assembled a cohort of known sexual abuse victims drawn from an existing 18-year cumulative sexual abuse report log of this HMO. This unique cohort will allow novel investigations of critical methodologic problems that have hampered sexual abuse research and provide prospective evaluation of physical symptoms in women with sexual abuse using objective measurement of both abuse status and health care utilization. We will examine the validity of retrospective sexual abuse reporting and the correlation of selfreport and interview methods of case determination. We will also identify the impact of this abuse on the subsequent production of medical symptoms, health risk behaviors (such as smoking, significant obesity, excessive drug and alcohol consumption, AIDS and other sexually transmitted diseases) and health care utilization. Using automated medical record data, chart reviews and personal interviews we will: 1) compare the pre- and post-abuse patterns of medical symptoms, health risk behaviors, and medical care utilization in women who report abuse in the survey; 2) compare the current and lifetime histories of medical symptoms, health risk behaviors, and medical care utilization of women who report abuse with a sample of women who do not report abuse.